CSIRO to demonstrate evidence for telehealth under NBN project

Written by Michael Wong on 09 May 2013.

The federal government has revealed the winning bidders for the $20.3 million grants program to evaluate NBN-enabled telehealth pilot projects, first announced in January last year, including the CSIRO planning the first large-scale use of patient-collected data uploaded to the PCEHR.

The Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, said the nine projects will help demonstrate how important high-speed broadband is to the future of healthcare.

“We now live in a world where … healthcare doesn't only happen in a hospital, and aged care doesn't always mean having to go into a nursing home,” Senator Conroy said.

Grant consulting firm Bulletpoint has been keeping a list of the successful projects and has provided full details on its website.

The projects will cover around 2500 patients in 50 NBN communities, and comprise successful bids from the CSIRO, the Royal District Nursing Service and Flinders University.

Feros Care, Leading Age Services Australia, Silver Chain Group, Illawarra Retirement Trust and UniQuest will deliver aged care programs, while the Hunter New England Health District in NSW will look at cancer patients and Integrated Living will examine care for older Aboriginal and Torres Strait Islander people.

The CSIRO has received two grants totalling $5 million, with $3m awarded to a project examining home monitoring of chronic disease for aged care, and $2m to extend its Remote-I indigenous eye care program to evaluate telehealth over satellite broadband.

The eye care project, which is being run in conjunction with WA Health and the Australian Society of Ophthalmologists, recognises that indigenous Australians are at much greater risk of poor eye health, particularly in remote communities.

Using the Remote-I telemedicine platform, 900 patients will be involved across three sites in Queensland and Western Australia. Technical assessment will also be carried out to determine satellite broadband's efficacy in delivering telehealth.

“This project will allow us to showcase how it can be rolled out to multiple rural and remote areas and help address the difficulties these communities face in accessing specialist eye care services.

“Our team is excited to be testing telehealth applications over the new satellite broadband service. By understanding the benefits, limits, and possible adaptations needed, we can design more effective telehealth services and help to overcome the barriers … in rural areas.”

Meanwhile, in the randomised-control trial evaluating home monitoring of patients with chronic disease, six sites have been chosen, comprising 450 patients who will be tracked over a year.

Participants will be drawn from patients with a history of chronic disease, or those hospitalised twice in the preceding 12 months.

TeleMedCare will provide the telehealth platform and iiNet will contribute the fibre and fixed-wireless NBN connections.

Data collected at home by the patient – such as blood pressure and ECG readings, spirometry, pulse oximetry, weight and temperature – will be fed into the PCEHR.

Sites have been chosen to give a cross-section of hospital- and community-based care models, and the project will also evaluate usability for patients and clinicians, organisational change-management, business-flow processes, and workplace cultures.

“We’re trying to work out how to scale up telehealth nationally, and to do that we need to learn a lot about how these particular sites are adopting telehealth,” CSIRO ICT Centre chief scientist, Branko Celler, said. “We’re hoping to produce a resource package for anyone that wishes to deploy telehealth.

“But further, we want to provide the data that will go to government and Treasury and policy-makers and funding agencies to confirm to them or otherwise that telehealth has a very good cost–benefit, and has improved healthcare outcomes.”

The CSIRO will also interpret the data collected to analyse “risk stratification”, which classifies whether patients are sick but stable, showing signs of improvement or acuity, or pending hospitalisation.

“If we can do that effectively, we can then orchestrate the best response – from the GPs, from the community nurses, from the health services that are around the patient – to stop them going to hospital,” Professor Celler said.

“There is very good evidence that telehealth in the right setting can reduce hospitalisation by anything between 10 and 40 per cent, depending on what the baseline circumstances are.

Professor Celler said that while this had been demonstrated internationally, there was not enough broad-based evidence from Australia.

“It’s the most comprehensive and the most carefully controlled study that I know of – and one of the biggest,” he said.

“Fundamentally, we want to demonstrate the impact telehealth has in improving the management of chronic disease – quite low cost and better outcomes – and deliver sufficient information to government and healthcare providers to scale this up nationally. That’s what’s happening worldwide, and we need the evidence for Australia.

“Our healthcare costs keep increasing. Telehealth methods in the home are increasingly shown to be cost-effective, to have a really big impact on reducing the burden of patients in hospitals.

Core measurements in the project will be completed by July next year, and the report handed down by the end of September, 2014.

Agree on both points! The project is investigating all aspects of deploying telehealth in a range of primary care and community settings, will gather the data and provide the evidence for any conclusions that may be reached.

It gives me hope that the CSIRO is going beyond Conroys brief, otherwise the results could have been scribed last January when the draft tender was released. I hope the other grant recipients take the same approach.

I am amazed that there is yet another trial! It is time to move past trials and start implementing this on a large scale.

This exact technology(TeleMedCare) was trialed by the Loddon Mallee Health Alliance about 5/6 years ago with 70/80 patients suffering from COPD, CHF and diabeties. And surprise surprise the overseas experience of reduced ED presentations, improved patient self awareness and the resulting improvement of condition management in conjunction with the GP were clearly evident as well as improved medications compliance.

The pilot was evaluated clinically by a LaTrobe University nurse educator with a doctorate, written up and reviewed and published.

The issue isn't whether the technology works but how to reimburse GPs for accessing the information, because they typically advanced the "I'm not getting paid for my time to monitor this data" argument and how to encourage the insurers, including Medicare to provide coverage for the end devices.

As a tax payer I am dismayed that the academics have grabbed cash that could be used to deploy these devices for another trial that will surprise surprise find out that the tecnology works but that the system doesn't know how to or have the money to fund widespread deployment.

The department should have cast there net wider during the assessment process!

Phil, I agree that there have been numerous trials in Australia evaluating telehealth services for CDM and I was involved in many of them! Whilst this is very frustrating, what is more frustrating is that the impediments to large scale deployment of telehealth in Australia have not been addressed. Also many of the projects previously undertaken were very small and not statistically robust, nor did they address issues of workplace culture, organisational change management, and many of the other issues that have prevented telehealth becoming a routine community based model of care for the management of Chronic Disease in the community. Whilst I share your frustration, this study will hopefully be of different scale and impact. It implements a case matched control protocol, operates across six different sites in five states, each with a different model of care for CDM, uses the full capability of the NBN, and evaluates a host of socio-economic, business process, and workplace cultural issues in addition to healthcare outcomes. We hope to finally provide local, statistically robust evidence that can inform government policy and provide a resources for those healthcare organisations which may wish to implement telehealth services. CSIRO will also be developing risk stratification and decision support algorithms that will facilitate the scaling up of telehealth services away from the 10's and 20's to the many thousands.